Health care for poor strains clinic, community

Monday

Nov 26, 2012 at 12:01 AM

When Dr. Bill Gilmer arrives at his clinic in Holly Hill, he is met with a stack of messages he is often unable to return.

LACEY MCLAUGHLINSTAFF WRITER

When Dr. Bill Gilmer arrives at his clinic in Holly Hill, he is met with a stack of messages he is often unable to return. The messages come from ailing residents who are out of options: An uninsured single mom who doesn't qualify for Medicaid, a small business owner who has cut insurance so he can keep his doors open, a self-employed artist who can't afford the prescription drugs she needs. The Jesus Clinic has not been able to make room for new patients for the past three years. While Gilmer does the best he can to fit in at-risk patients, he wishes he had room to help more. "If it's a 20-year-old with a cold it's unlikely that person will be seen. If it's a 55-year-old with high blood pressure and an impending heart attack in the next year or two that person is probably going to get an acceptance," he said. "It's tough to pick." The Jesus Clinic isn't the only affordable clinic in the area feeling the burden of an increased need for services. Faced with a sputtering economy, rising healthcare costs and shrinking Medicaid budgets, faith-based, tax-supported and privately-funded clinics and hospitals are being stretched to care for the uninsured, and that cost is often passed on to consumers. While federal health care reform looms in the distance, Gilmer said the people calling his clinic can't wait for the government. They need help now.

'THE HUGE DEMAND'

Gilmer, a part-time emergency room doctor at Florida Hospital Memorial Medical Center in Daytona Beach, and his wife, Pam, a former nurse at Halifax Health Medical Center, opened the primary care clinic in 2006 with primary funding from Daytona Christian Church, Tomoka United Christian Church and Florida Hospital Memorial Medical Center. Four nights a week Gilmer and a handful of medical professionals and volunteers donate their time to the clinic, which has an annual operating budget of $50,000 and donates more than $1.2 million worth of care to the community each year, Gilmer said. U.S. Census data reports that in Volusia County, 88,756 residents had no health insurance in 2011. That number was 16,865 in Flagler County. At an age when Gilmer, 72, could be eyeing retirement, he is forging ahead with an ambitious plan to expand affordable health care services for those who often slip through the cracks. Gilmer is raising funds for a larger clinic that includes additional patient rooms, a dental clinic and space for minor operations. "We have manpower and volunteers but we don't have enough space here to meet the huge demand," Gilmer said. To be eligible to receive care at the Jesus Clinic, patients must be employed, not have insurance or qualify for Medicaid, be a resident of Volusia County, have valid identification and an income that is at or below 200 percent of the federal poverty line. The patients who come to Gilmer's clinic are the working poor who have no other options for routine care, Gilmer said. Robert Nicholas, owner of a small barbershop in Ormond Beach, has been coming to the Jesus Clinic for years for routine care. "It feels insulting that I can be successful enough to have my own business in this country but I can't afford health insurance," Robertson said. Lori and Jonathan Moss, a young couple who both work at Chick-fil-A in Port Orange, came to the clinic on a recent evening because Lori had a viral infection. Jonathan, 24, and Lori, 20, said their company offers insurance but at $500 a month they can't afford it. The couple has more than $19,000 in hospital bills from a hernia surgery Jonathan had recently and without the Jesus Clinic, they might be facing even more bills. Jonathan is in the process of starting his own landscaping business and said he hopes to have enough income in the future to purchase health insurance for him and his wife. "I don't think health insurance should be required (by the federal government) but I think it should be more affordable," Jonathan said. "We aren't looking for a handout, we are looking for a hand up." Gilmer's patients include the young and old under the age of 65. Many of them have chronic health conditions such as heart disease and diabetes and by treating them regularly Gilmer is able to prevent expensive emergency room visits at hospitals such as Halifax Health Medical Center in Daytona Beach. Florida has some of the strictest Medicaid requirements in the country and does not cover childless adults, which make up the majority of Gilmer's patients. When patients need diagnostic services or operations, Gilmer and his wife have a network or surgeons, radiologists and oncologists who donate their time and services on a rotating basis. Gilmer sees his clinic as a solution to lessening the financial burden on taxpayers and local medical providers. "Twenty one percent of adults in the state of Florida have no health insurance," Gilmer said. "They just don't go to the doctor, and use the emergency room when they have urgent matters. If someone has no insurance and goes to the ER for a heart attack, the public pays for that service and the hospital gets no income."

HIGH NEEDS, HIGH COSTS

The cost of providing care for the uninsured places huge burdens on the area's medical providers. Halifax Health Medical Center, the county's largest public hospital, is facing rising insurance costs and a decline in tax revenues at the same time the costs for indigent care are rising. Halifax officials say the hospital also faces a $7 million reduction in Medicaid reimbursements in 2012 combined with a $4 to $5 million drop in tax revenues. Through its patient assistance program, Halifax offers a sliding scale of affordable health services for those who do not qualify for Medicaid. The hospital also provides funding and physicians to care for the homeless population at the Star Center on North Street and the Keech Pediatric Neighborhood Care Clinic. Last year Halifax reported that the hospital was able to divert more than 400 emergency room visits to the Star Center clinic and save 5.3 million by taking on 1,412 homeless cases at the free clinic. In 2012 so far the hospital provided a total of $39 million in uncompensated care and is projected to spend $46 million in 2013. The hospital is committed to providing care for the indigent population while increasing revenue so consumers are not burdened with rising costs, said Halifax Health Chief Marketing Officer Ann Martorano. "Health care financing already shifts some of this cost burden to the commercial insurers and ultimately, this could be passed on to the consumer through increased premiums," Martorano wrote in an e-mail. "We are very sensitive to that and are focused on finding ways to operate as efficiently as possible and to find new sources of revenue to help offset these costs." Because Halifax provides services that benefit the entire community, Martorano said, it is important to attract paying patients so that Halifax can stay financially viable. Even with the availability of affordable services, a medical emergency puts the working poor at risk of falling deeper into poverty or homelessness. While helping out on a friend's farm in Samsula in September, Port Orange resident Phillip Swaney suffered an orbital blowout fracture from being hit in the eye socket when he was placing a fence post into the ground. The force of the blow caused his retina to detach and as a result he suffered extreme headaches and double vision. Through Halifax's patient assistance program, he received corrective surgery and is currently working with the hospital to find out how much of the $40,000 in medical bills he will have to pay. In the meantime, he hasn't been able to return to work as a construction worker. His fiancée Heather Wollschlager lost her left index finger and severely damaged her middle finger in a skill saw accident last month and has not yet regained function in her left hand. Wollschlager would have likely qualified for patient assistance at Halifax but because she went to the emergency room at Bert Fish Medical Center in New Smyrna Beach and was transferred to Orlando Regional Medical Center, she faces $17,000 in medical bills. She has paid out of pocket for prescriptions and physical therapy but can no longer afford to attend her therapy sessions. The couple have picked up odd jobs such as housekeeping but have no steady income. As a result, they lost their apartment and their cellphones have been turned off. They sold their engagement rings and their scooter, which was their only mode of transportation. The couple are currently staying with a friend but must find another place to live by the end of December. The couple said they want to return to work so that they can have enough money to get married and start their own business. But in the meantime, they need help. "I understand the frustration people have with those who take advantage of benefits they are given," Wollschlager said. "But to think that everyone who needs assistance is irresponsible or on drugs or lazy, it's not true. Life happens. He didn't ask to get hit in the face. I didn't ask to get my finger cut off."

FOOTING THE BILL

Because Wollschlager and Swaney can't pay for their medical bills, that cost will likely be passed on to consumers. The Safety Net Hospital Alliance of Florida reports that taxpayers help foot the bill for the 3.8 million uninsured who receive care in emergency rooms in Florida each year. "In order to cover the cost of uncompensated care, we have to rely on commercial insurance rates to subsidize these services," Martorano said. "Many of these services we provide do not pay for themselves such as trauma, neonatal intensive care, etc. These services are for the entire community, not just the uninsured, and we have to make sure the rates we charge the commercial insurers are enough to help cover some of these expenses." The fate of one piece of the puzzle that could give more people access to health care — the Affordable Care Act — remains unknown. Gov. Rick Scott appeared to soften his position recently when he told the Associated Press he would negotiate with the federal government about setting up health insurance exchanges. The exchanges would create a marketplace in which businesses and the government would compete for low insurance rates for individuals and small businesses. Scott had previously said he would not go along with health care overhauls imposed by the federal government. Florida missed a deadline to submit a plan for setting up the exchanges to the U.S. Department of Health and Human Services Nov. 16, but that deadline was extended to Dec. 14. Scott said previously that Florida would not expand its Medicaid program to cover an additional 900,000 uninsured — including childless adults — because of the cost. The current Medicaid budget for the state is $20 billion, with the federal government paying just over half. When it comes to expanding Medicaid, however, Safety Net Hospital Alliance of Florida President Tony Carvalho said the state Legislature will play a large role in that decision. Expanding the program would bring $77 million to Volusia County alone in federal and state funds, Carvalho said. If approved the federal government would pay 100 percent of the cost to expand the program for the first three years and 90 percent of the costs until 2020. "The state of Florida knows that this is a critical issue and I expect this to be thoroughly debated in the Legislature next session," Carvalho said. "It's too early to predict what will happen but I predict that they will pass some form of health reform." Even with expansion, Carvalho said there would always be people who slip through the cracks, and the need for community clinics like Gilmer's will remain. But the demands for Gilmer's clinic might be alleviated, he said. Newly elected Republican state Sen. Dorothy Hukill of Port Orange said while the need for affordable health care in Volusia County is great, it's too early to know what position she will take on expanding Medicaid or other reforms until next legislative session. "All options are on the table but we need to help the economy recover at the same time," she said. "Because of the economy more people need health care than ever before. That's why focusing on getting people back to work will help the problem." Back at the Jesus Clinic, time can make a crucial difference in outcomes for Gilmer's patients. The hardest part for Gilmer is not always being able to help his patients get the treatment they need. "I had a women that we diagnosed with uterine cancer," Gilmer said. "She had to wait for a year until she could find a doctor to give her a hysterectomy. Should someone have to wait a year to get a procedure like that? As a doctor it's disappointing and frustrating and I wish I could do more."